What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?

Venipuncture for blood work should be performed on the affected arm.

The blood pressure (BP) cuff should not be applied to the affected arm.

The affected arm should be held down close to the woman's side.

The affected arm should be used for intravenous (IV) therapy.

Answer and Explanation

The Correct Answer is B

Choice A reason: This is incorrect because venipuncture for blood work should be avoided on the affected arm. The mastectomy may have involved the removal of lymph nodes, which can impair the lymphatic drainage and increase the risk of lymphedema (swelling) in the arm. Venipuncture can cause further damage or infection to the arm.

Choice B reason: This is correct because the BP cuff should not be applied to the affected arm. The BP cuff can exert pressure on the arm and interfere with the blood and lymph flow. This can also increase the risk of lymphedema or pain in the arm.

Choice C reason: This is incorrect because the affected arm should not be held down close to the woman's side. The woman should be encouraged to elevate the arm above the level of the heart and perform gentle exercises to promote circulation and prevent stiffness. The arm should not be immobilized or restricted.

Choice D reason: This is incorrect because the affected arm should not be used for IV therapy. IV therapy can introduce fluids or medications into the arm that can affect the blood and lymph flow. It can also cause irritation or infection to the arm.

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Correct Answer is D

Explanation

Choice A reason: Cheese is a good source of calcium, protein, and vitamin B12, but not folates. Folate is a water-soluble vitamin that is essential for the synthesis of DNA and the prevention of neural tube defects in the fetus.

Choice B reason: Potatoes are a good source of carbohydrates, potassium, and vitamin C, but not folates. Folate is found mainly in plant-based foods, especially dark green vegetables.

Choice C reason: Chicken is a good source of protein, iron, and zinc, but not folates. Folate is more abundant in legumes, nuts, and seeds than in animal products.

Choice D reason: Green leafy vegetables are a good source of folates, as well as vitamin A, vitamin K, and fiber. Folate is also known as folic acid when it is added to fortified foods or supplements. Pregnant women need at least 600 micrograms of folate per day.

A. Have the patient stand up and retake her blood pressure. B. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. C. Have the patient sit down and hold her arm in a dependent position. D. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

Correct Answer is D

Explanation

Choice A reason: This is not a good intervention, as it may worsen the symptoms of faintness, dizziness, and agitation. Standing up can cause a sudden drop in blood pressure (orthostatic hypotension), which can reduce the blood flow to the brain and the fetus. This can cause lightheadedness, blurred vision, and loss of consciousness in the woman, as well as fetal distress or hypoxia.

Choice B reason: This is not a good intervention, as it may also worsen the symptoms of faintness, dizziness, and agitation. Lying supine can cause compression of the inferior vena cava (a large vein that returns blood to the heart) by the gravid uterus, which can reduce the cardiac output (the amount of blood pumped by the heart) and the blood pressure. This can cause nausea, sweating, and visual disturbances in the woman, as well as fetal distress or hypoxia.

Choice C reason: This is not a good intervention, as it may not improve the symptoms of faintness, dizziness, and agitation. Sitting down and holding the arm in a dependent position can lower the blood pressure in the arm, but not in the rest of the body. This can cause inaccurate readings of the blood pressure and delay the detection of hypotension or hypertension. This can also cause discomfort and pain in the arm due to impaired circulation.

Choice D reason: This is the best intervention, as it can relieve the symptoms of faintness, dizziness, and agitation by improving the blood flow to the brain and the fetus. Turning to the left side can reduce the pressure of the uterus on the inferior vena cava and increase the cardiac output and the blood pressure. This can also optimize the placental perfusion (the blood flow to the placenta) and the fetal oxygenation.

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What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?

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